The boardwalk at midday
It was 10 PM and I was weaving on the boardwalk. “Are you okay? Are you okay,” my acquaintance Susan asked several times. I couldn’t respond. My brain wasn’t working. Like a firefly it was flitting on, off, on, off, refusing to hold its light.
I was still looking at google maps on my phone. I’d been leading us back from a fireworks display in a neighboring seaside town to our mutual friend Carol’s house. We’d been walking twenty-five minutes and I knew we were practically there. Yet even after having done this walk three times earlier that day nothing looked familiar. The street names on my phone no longer made any sense.
I had enough mindshare to register that Susan was frightened. But not enough to explain anything. Then I heard her talking on her phone and almost instantly out of the darkness Carol stood before us. We’d been only 100 meters from her house.
She said to Susan, “It’s her blood sugar.” I remember little except walking into the house and then bouncing my way to the back bedroom to check my blood sugar. Carol followed me with a cookie in her outstretched hand. “Wait,” I said, “Let me check.” Sure enough, 32 mg/dl. “No, not a cookie,” I said, “These” as I took out three glucose tablets and began chewing.
Within minutes I got a text from Livongo, my glucose meter company. “You’re low. Can you manage your low blood sugar?” “Yes” I wrote back. Another text came, “After you treat it, make sure to check again in 15 minutes. Keep me posted.”
As you’ve surmised, I came through my episode of severe hypoglycemia (low blood sugar). It took: two friends, my meter, four strips, my Livongo coach, three glucose tablets, a second slice of rhubarb pie with ice cream, half a banana, and the warmth and safety of the other three people in the house keeping an eye on me for the next hour. I went to bed at 136 mg/dl and woke up at 129 mg/dl. Whew!
I have only experienced severe hypoglycemia about four times in forty-five years with type 1 diabetes. The worst time was in London early in my marriage.
This, however, was the first time that I actually appeared drunk, as I’ve so often read is a symptom of severe hypoglycemia. A symptom that has gotten people with type 1 diabetes falsely arrested.
I don’t know why that appearance of seeming drunk happened this time. Or why I didn’t get the warning signals I usually do that my blood sugar is dropping, the rapid heartbeat, hunger, sweating, shaky feeling.
I do, however, know why this happened, although that’s not the point of this story, which I’ll come to in a bit. The why is I took too much insulin before dinner. I also know why that happened:
Spending the weekend at my friend’s beach house I was eating foods other than what I usually eat. That meant more guesswork, and more room for error, regarding how many carbohydrates I was eating and needed to cover.
Miscommunication. I thought after dinner we were walking only two streets away to the ferry dock to watch the sun set. I had missed the announcement that we were walking thirty minutes away to a neighboring town for fireworks. That also meant a thirty-minute walk back. An hour of exercise I had not calculated for.
I expected the homemade strawberry rhubarb pie my friend made, that I decided I was going to allow myself, to be served right after dinner. I dosed for it. However, finishing dinner, the group consensus was we should enjoy the pie after we returned from the fireworks. Knowing I’d dosed for it, I ate my piece before the walk. Yet, I guessed it would raise my blood sugar more than it did.
If you’re wondering where the husband was in all this, he was on an island off of Vancouver attending a workshop. He also didn’t get the Livongo coach message until the next day because there was very spotty cell/internet reception on the island.
Which brings me to some hard earned experience I wish to share so we’re all a little safer, you and/or your loved ones.
1. Routine is a tool - It’s one of my most powerful tools to manage my diabetes. I typically eat the same type of food, often the same foods, same amount of carbs, about the same time every day. No, I don’t mind at all. I like what I eat and I like that it leads to fewer errors. Think about it.
2. Let others know - When you’re out of your everyday routine (see above), make sure someone around you knows you have diabetes and what to do if your blood sugar goes low. The husband, who can now after sixteen years of marriage probably qualify as a diabetes educator, was useless as my protector in this situation. It would have been better if Susan knew this was low blood sugar and if Carol knew a cookie would take too long to raise my blood sugar and gone instead for juice, honey or jam. That knowledge is on me to share.
3. Control, “fuggedaboudit!”- We constantly hear we can/should control our blood sugar but we can’t. Without a fully functioning pancreas your blood sugar is at the whim, and mercy, of dozens of variables: food, exercise, stress, sleep, temperature, carbohydrate guessing, insulin absorption, accuracy of devices, metabolic functions that are uncontrollable and imprecise and group decisions you are informed about too late.
4. Self-Management - Diabetes education is called Diabetes Self-Management Education. We are a rugged, individualistic society. But there are times you need the help of others. (See point number 2.) And as much as we’d like to think it’s all about self-efficacy, society has a role to play. People will make the healthy choice when the healthy choice is the easy choice: we are entitled to healthier food choices more available and more affordable, streets that are easier to be active on and realize asking for help is a sign of strength, not weakness.
5. Blood Sugar is Unpredictable - No one has it in the bag. Not me - who’s successful most of the time with my management - not anyone. Blood sugar has an unpredictable component to it. So, learn everything about diabetes, teach your friends and loved ones, as I will do a better job of going forward, carry a form of glucose on you at all times, use a CGM if you can and wear a medic alert bracelet. Need I say my CGM and alert bracelet were, shamefacedly, at home.
Lastly, when you get through a hard or harrowing episode or few days, pat yourself on the back. You live with something most people don’t even see, and you made it through another day. Hallelujah!